Related Experiment Video
Updated: Jan 8, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Surgical Management of Severe Congenital Ptosis: A Systematic Review
Hanyi Jiang1, Zhiwei Chen2, Yilue Zheng1
1Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences.
Insights
Severe congenital ptosis surgery requires individualized approaches. Frontalis suspension is preferred for poor levator muscle function, while other techniques suit different anatomical conditions.
Area of Science:
- Ophthalmology
- Plastic Surgery
- Pediatric Surgery
Background:
- Severe congenital ptosis, often due to levator palpebrae superioris (LPS) underdevelopment, impacts vision and facial appearance.
- Current surgical options for congenital ptosis lack consensus on optimal technique and long-term results.
Purpose of the Study:
- To systematically review surgical techniques for severe congenital ptosis.
- To develop an evidence-based decision-making algorithm for surgical management.
Main Methods:
- Systematic review of English-language studies (2014-2024) on severe congenital ptosis (MRD1 <1 mm, LPS function ≤4 mm).
- Included primary surgical interventions with detailed techniques and ≥6 months follow-up.
- Excluded acquired ptosis and syndromic cases; followed PRISMA guidelines.
Main Results:
- Fourteen studies were analyzed, identifying three primary surgical approaches: frontalis suspension, levator resection, and conjoint fascial sheath-levator complex fixation (CFS+LM).
- Surgical outcomes were influenced by patient age, LPS function, and anatomical maturity.
Conclusions:
- Individualized surgical management is crucial for severe congenital ptosis.
- An algorithm based on age and LPS function guides technique selection.
- Frontalis suspension is recommended for poor LPS function; levator resection and CFS-based methods are alternatives when feasible.
Objective:
Severe congenital ptosis, primarily caused by levator palpebrae superioris (LPS) underdevelopment, may impair visual development and facial aesthetics. Although multiple surgical techniques exist, optimal procedure selection and long-term outcomes remain debated.
Methods:
A systematic review was conducted following PRISMA guidelines. The authors searched PubMed, ScienceDirect, and Google Scholar for English-language studies (2014-2024) on severe congenital ptosis (MRD1 <1 mm, LPS function ≤4 mm). Inclusion criteria encompassed primary surgical intervention, detailed technique description, and ≥6 months of follow-up. Studies of acquired ptosis or syndromic cases were excluded. Two reviewers independently performed screening, data extraction, and quality assessment.
Results:
Fourteen studies were included. Three core surgical approaches were identified: (1) frontalis suspension, (2) levator resection, and (3) conjoint fascial sheath-levator complex fixation (CFS+LM). Outcomes varied by patient age, LPS function, and anatomical maturity.
Conclusions:
Surgical management of severe congenital ptosis should be individualized. Based on the evidence, a decision-making algorithm was developed incorporating patient age and LPS function. Frontalis suspension remains the preferred option for markedly impaired LPS function, whereas levator resection and CFS-based techniques are viable alternatives when anatomical conditions allow. Prospective studies with standardized outcome measures are needed to confirm long-term effectiveness.
Level Of Evidence:
Level III.
